Barrett’s Esophagus

Barrett’s esophagus is a condition affecting the lining of the esophagus. Esophagus, also called the feeding tube, carries food and liquids from the mouth to the stomach. This lining is replaced with a tissue that is similar to the intestinal lining. This process is called intestinal metaplasia. Barrett’s esophagus is a precancerous condition that has intestinal metaplasia when the tissue sample is looked under a microscope. Patients with Barrett’s esophagus are at increased risk of adenocarcinoma of the esophagus, which is a type of cancer affecting the lower part of the esophagus (feeding tube).

How common is Barrett’s esophagus?

Barrett’s esophagus is estimated to affect 1.6 to 6.8% of the U.S. population. Average age at the diagnosis is 55. Men develop Barrett’s esophagus twice as often as women, and white men are affected more frequently than men of other races.

What causes Barrett’s esophagus?

The exact cause of Barrett’s esophagus is unknown, but gastroesophageal reflux disease (GERD) is a risk factor for Barrett’s esophagus. Gastroesophageal reflux disease is a condition in which stomach contents flow back up into the esophagus. The reflux stomach acid that touches the lining of the esophagus can cause heartburn and damage the cells of the esophagus. Heartburn, also called acid indigestion, is an uncomfortable, burning feeling in the mid chest or in the upper part of the abdomen.

How is Barrett’s esophagus diagnosed?

Barrett’s esophagus is diagnosed with an upper endoscopy, also called EGD (esophagogastroduodenoscopy) and biopsy. Upper endoscopy involves using an endoscope, a small, flexible tube with a light to see the upper GI tract. The test is performed at a hospital or outpatient center by a gastroenterologist who specializes in digestive diseases. Our group members are board-certified gastroenterologists specializing in digestive and liver disorders. This procedure is done right here at our endoscopy center, affiliated with our practice. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to the monitor, allowing close examination of the intestinal lining. The person will receive sedation while the procedure is being done. We, the gastroenterologists, perform biopsy, which means obtaining a small sample of tissue from the esophagus to be examined under a microscope. The mucosa of the gastrointestinal tract does not have pain fibers, and so the patients will not feel pain during biopsy. A pathologist is a doctor who specializes in examining the tissue samples under a microscope and reviews the esophageal biopsy to determine whether Barrett’s esophagus is present in a particular patient or not. Barrett’s esophagus is often diagnosed when a person has an upper GI endoscopy (EGD) for GERD symptoms.

What is the risk of getting adenocarcinoma for a person with Barrett’s esophagus?

The adenocarcinoma in people with Barrett’s esophagus is about 0.5% per year. Typically before adenocarcinoma develops, precancerous cells appear in the Barrett’s tissue. This condition is called dysplasia and is classified as high-grade or low-grade dysplasia. Barrett’s esophagus may be present for many years before cancer develops. A periodic upper endoscopy/EGD with biopsy is often used to monitor people with Barrett’s esophagus and watch for signs of cancer development. This approach is called surveillance. The experts have not reached a consensus regarding frequency of surveillance, but it is reasonable to consider upper endoscopy every two years with multiple biopsies in patients who have Barrett’s esophagus. More frequent endoscopies and photodynamic therapy or radiofrequency ablation are used for people with low-grade or high-grade dysplasia.

How is Barrett’s esophagus treated?

There are multiple options available, including presence of dysplasia or tendency for development of cancer. Treatment options include medications, surgery, endoscopic ablation therapy, and endoscopic mucosal resection. Predominantly patients with Barrett’s esophagus are treated with medications such as proton pump inhibitors, including omeprazole, pantoprazole, esomeprazole, and dexlansoprazole. The latest medicine to be approved is dexlansoprazole (Dexilant). Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells. At present, the medical literature supports the use of radiofrequency ablation in patients with low-grade or high-grade dysplasia. Surgical therapy is an alternative, and Nissen fundoplication or fixing of hernia with some other maneuvers is useful in patients with GERD, as well as Barrett’s esophagus. Either medications or surgery do not reverse the damage caused to the mucosa of patients with Barrett’s esophagus. The incidence of cancer may be decreased with medical or surgical management. The benefit of radiofrequency ablation or photodynamic therapy or endoscopic mucosal resection in patients with Barrett’s esophagus is yet to be determined, but a few studies definitely showed benefit of these modalities in patients with low-grade or high-grade dysplasia. Basically low-grade or high-grade dysplasia increases the potential for the development of cancer. Diet and exercise certainly decrease the potential for cancer. Losing weight and taking aspirin or some other antiplatelet and antioxidant drugs are beneficial.

The main points to remember in this condition, Barrett’s esophagus, include:

  • Barrett’s esophagus is a condition in which the tissue lining of the esophagus is replaced by tissue that is similar to the intestinal lining.
  • The prevalence of Barrett’s esophagus is unknown, but it is estimated to affect 1.6 to 6.8% of the population.
  • Exact cause of Barrett’s esophagus is unknown, but gastroesophageal reflux (GERD) is a risk factor for this condition. Between 5 and 10% of people with GERD develop Barrett’s esophagus. Other risk factors for Barrett’s esophagus include obesity and smoking. Some studies suggest that genetics or inherited genes may play a role.
  • Barrett’s esophagus is diagnosed with an upper intestinal endoscopy and biopsy of the affected area of the esophagus.
  • The risk of adenocarcinoma in patients with Barrett’s esophagus is about 0.5% per year.
  • Treatment options include medications, endoscopic ablation therapy, endoscopic mucosal resection, and surgery.

We hope this discussion will help to diagnose and appropriately monitor patients with Barrett’s esophagus. One of the doctors in our group or the nursing staff of our group will be happy to discuss with you if you have any symptoms of GERD or Barrett’s esophagus that require attention. You can have your family physician refer you to our practice if your primary care doctor feels that you need the attention of a gastroenterologist. One of the gastroenterologist in our group will be happy to see you.